CASAC Alcohol And Drug Counselor 4 — Questions and Answers
Question 1: A client in early recovery reports intense cravings triggered by driving past a bar where they used to drink. This is best described as which type of trigger?
- Internal emotional trigger
- Environmental/external cue trigger (Correct answer)
- Interpersonal conflict trigger
- Physiological withdrawal trigger
Correct answer: Environmental/external cue trigger
Environmental or external cue triggers are conditioned stimuli (places, people, objects) associated with past substance use that elicit cravings.
Question 2: Under HIPAA and 42 CFR Part 2, which of the following disclosures requires explicit written consent from a substance use disorder client?
- Reporting suspected child abuse to a mandated agency
- Sharing records with another treating provider in an emergency
- Disclosing treatment information to a family member for care coordination (Correct answer)
- Notifying public health authorities of a communicable disease
Correct answer: Disclosing treatment information to a family member for care coordination
42 CFR Part 2 imposes stricter protections than HIPAA; disclosing SUD records to family members for care coordination requires the client's specific written consent.
Question 3: The transtheoretical model stage in which a client acknowledges a problem but has no intention of changing within the next six months is called:
- Precontemplation (Correct answer)
- Contemplation
- Preparation
- Maintenance
Correct answer: Precontemplation
In precontemplation the individual does not yet recognize a problem or intends no change in the foreseeable future (within six months).
Question 4: A counselor notices a supervisee consistently avoids confronting clients about relapse. This pattern is best addressed through:
- Peer consultation only
- Formal disciplinary action
- Clinical supervision focused on countertransference (Correct answer)
- Reassignment of the supervisee's caseload
Correct answer: Clinical supervision focused on countertransference
Clinical supervision that explores countertransference helps the supervisee identify personal reactions interfering with effective confrontation of relapse behavior.
Question 5: Which neurotransmitter system is most directly associated with the rewarding effects of alcohol and opioids that reinforce continued use?
- Serotonergic system
- Dopaminergic mesolimbic pathway (Correct answer)
- Noradrenergic system
- GABAergic brainstem pathway
Correct answer: Dopaminergic mesolimbic pathway
Both alcohol and opioids increase dopamine release in the nucleus accumbens via the mesolimbic pathway, producing the reinforcing pleasurable effects.
Question 6: A client on methadone maintenance asks if they can drink alcohol socially. The most clinically appropriate counselor response is to:
- Permit moderate use since methadone replaces opioids, not alcohol
- Advise complete abstinence due to dangerous CNS depression risk (Correct answer)
- Suggest limiting to two drinks per occasion as per NIAAA guidelines
- Defer the question entirely to the prescribing physician
Correct answer: Advise complete abstinence due to dangerous CNS depression risk
Combining methadone with alcohol causes additive CNS depression that can lead to respiratory depression and death, so complete abstinence from alcohol is recommended.
Question 7: In a group therapy session for SUD, a member begins to monopolize by telling lengthy stories. The most effective facilitator intervention is to:
- End the group session early to prevent harm
- Gently interrupt and redirect attention to the group's reactions (Correct answer)
- Ask the monopolizing member to leave the session
- Remain silent so other members can self-regulate
Correct answer: Gently interrupt and redirect attention to the group's reactions
A skilled facilitator redirects the monopolizer by inviting group members to respond, turning the behavior into a therapeutic opportunity without shaming the individual.
CASAC Alcohol And Drug Counselor 4
A client in early recovery reports intense cravings triggered by driving past a bar where they used to drink.
This is best described as which type of trigger?